Dysarthria can result from congenital conditions, or it can be acquired at any age as the result of a neurologic injury, disease, or disorder. The scope of this page is limited to acquired dysarthria in adults.
See the Dysarthria Evidence Map for summaries of available research on this topic.
Dysarthria refers to a group of neurogenic speech disorders characterized by “abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production” (Duffy, 2020, p. 3).
These changes are due to one or more sensorimotor problems, including weakness or paralysis; incoordination; involuntary movements; or excessive, reduced, or variable muscle tone (Duffy, 2020). Dysarthria can adversely affect intelligibility of speech and/or naturalness of speech. Dysarthria may also co-occur with other neurogenic language, cognitive, and swallowing disorders.
The predominant framework for differentially diagnosing dysarthria is based on a perceptual method of classification (Darley et al., 1969a, 1969b, 1975). This method primarily relies on the auditory perceptual attributes of speech that point to the underlying pathophysiology. The perceptual attributes are used to characterize the dysarthrias and, along with pathophysiological information, can help identify an underlying neurologic illness.
The primary types of dysarthria identified by perceptual attributes and the associated localization of pathophysiology (Duffy, 2020) are as follows:
For perceptual attributes associated with specific types of dysarthria, please see Distinguishing Perceptual Characteristics and Physiologic Findings by Dysarthria Type.
Incidence is the number of new cases of a disorder or condition identified in a specific time period. Prevalence is the number of individuals who are living with the disorder or condition in a given time period. Dysarthria is present in many neurologic diseases. As such, its incidence and prevalence vary based upon the nature and course of the underlying condition; condition severity; and location of lesion, if present. Estimates of dysarthria prevalence in adults secondary to these neurologic conditions are as follows:
Signs and symptoms of dysarthria include perceptual speech characteristics and physical signs that vary by dysarthria type (see Distinguishing Perceptual Characteristics and Physiologic Findings by Dysarthria Type). Dysarthria can alter speech intelligibility and/or speech naturalness by disrupting one or more of the five speech subsystems—respiration, phonation, articulation, resonance, and prosody.
Perceptual speech characteristics are grouped below by the subsystem that contributes most to the feature; however, subsystems associated with some characteristics can vary based on the individual. For example, reduced loudness may be a laryngeal problem for some individuals and a respiratory problem for others. In addition, due to the interactive nature of the speech subsystems, disruptions in one subsystem can have an impact on others. For example, impairments in respiration, phonation, articulation, and/or resonance may be responsible for prosodic deficits.
Physical signs in the articulatory structures (e.g., head, jaw, lip, tongue) may include the following:
Many neurologic illnesses, diseases, and disorders—both acquired and congenital—can cause dysarthria. Listed below are examples of some specific etiologies, grouped into broad categories (Duffy, 2020).
Speech-language pathologists (SLPs) play a central role in the screening, assessment, diagnosis, and treatment of persons with dysarthria. The professional roles and activities in speech-language pathology include clinical services (diagnosis, assessment, planning, and treatment); counseling, education, administration, and research; and prevention and advocacy. See ASHA’s Scope of Practice in Speech-Language Pathology (ASHA, 2016).
The following roles fall within the scope of practice for SLPs:
As stated in the Code of Ethics (ASHA, 2023), SLPs who serve this population should be specifically educated and appropriately trained to do so. SLPs who diagnose and treat dysarthria must possess skills in the differential diagnosis and management of motor speech disorders. They must have specialized knowledge of the following:
See the Assessment section of the Dysarthria Evidence Map for pertinent scientific evidence, expert opinion, and client/care partner perspective.
Screening for dysarthria is pass/fail and identifies the need for further assessment. Screening may also result in referral for other examinations or services. It does not provide a diagnosis or a detailed description of the severity and characteristics of speech deficits associated with dysarthria.
An SLP conducts the assessment of individuals with suspected dysarthria using both standardized and nonstandardized measures. See ASHA’s resource on assessment tools, techniques, and data sources for more information.
The goals of dysarthria assessment are to
See Duffy (2020) and Freed (2020) for examples of dysarthria assessment procedures.
The severity of the disorder does not necessarily determine the degree of disability. Speech-related disability will depend on the communication needs of the individual, the perceived impact of the disorder, and the comprehensibility of their speech in salient contexts.
Consistent with the World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) framework (ASHA, 2016; WHO, 2001), the assessment identifies and describes
See Person-Centered Focus on Function: Dysarthria [PDF] for an example of assessment data consistent with the ICF.
The assessment section below is not prescriptive; it outlines the components of a comprehensive evaluation. Some components may not be applicable in all clinical settings.
Components of case history include the following:
This is an assessment of speed, strength, range, accuracy, coordination, and steadiness of nonspeech movements as well as an assessment of the speech subsystems using objective measures, as available. The following are typically included:
A clinician uses auditory-perceptual approaches in addition to standardized assessments to evaluate speech production (Pernon et al., 2022). The type of speech sampling used in the auditory-perceptual assessment varies based on the areas that the clinician wants to evaluate. Speech sampling can include
A speech production evaluation targets the following areas:
Phonation—the ability to voice phonemes using vocal fold vibrations in the larynx (Freed, 2020). Atypical vocal quality (e.g., breathy, harsh, strained) and difficulty changing loudness and pitch can indicate neuromotor damage to the phonatory system. See ASHA’s Practice Portal page on Voice Disorders.
Articulation—a combination of appropriate timing, direction, force, speed, and placement of the articulators (Freed, 2020). The following articulation tasks can also reveal diagnostic information:
Prosody—use of variations in pitch, loudness, and duration to convey emotion, emphasis, and linguistic information (e.g., meaning, sentence type, syntactic boundaries); speech naturalness reflects prosodic adequacy. Targeted prosodic tasks include asking and answering questions, contrastive stress tasks, and reading statements using prosodic variation to express different emotions.
Speech intelligibility—the degree to which the listener (familiar or unfamiliar) understands the individual’s speech signal. Intelligibility and comprehensibility are typically reported as a percentage of words correctly identified by a listener.
Additional areas of assessment may include the following:
Assessment may result in the following outcomes:
|Language processing deficits||No||No||Yes|
|Consistent error patterns*||No||Yes||No|
|Groping for articulatory postures||Yes||No||No|
*See the Distinguishing Dysarthria From AOS and Distinguishing Dysarthria From Aphasia sections below for further details.
Please note that the chart above does not capture all the nuances of differential diagnosis of dysarthria. The information below may further clarify this subject.
Given the overlap in speech characteristics and other deficits across the dysarthrias, it may be difficult to determine dysarthria type (Fonville et al., 2008; Van der Graaff et al., 2009; Zyski & Weisiger, 1987). However, accurate differentiation supports treatment planning and can assist in the physician and medical team’s efforts to determine an underlying diagnosis if it is not known. See Distinguishing Perceptual Characteristics and Physiologic Findings by Dysarthria Type.
Listed below are characteristics and comparisons often used to distinguish dysarthria from AOS. Some dysarthria types (e.g., ataxic, hyperkinetic, and unilateral upper motor neuron) share some characteristics with AOS and can be difficult to distinguish (Bislick et al., 2017; Duffy, 2020).
For more information about AOS, see ASHA's Practice Portal page on Acquired Apraxia of Speech.
Aphasia affects language comprehension and expression; dysarthria affects only speech production. Dysarthria can significantly compromise speech intelligibility and speech naturalness; however, delays during speech and/or attempts by the speaker to revise content might indicate language expression problems associated with aphasia. In such cases, it may be necessary to assess written language expression and oral and written language comprehension to make a definitive diagnosis. If deficits are found in these modalities, it is likely that language problems are contributing to verbal expression difficulties (Duffy, 2020). For more information about aphasia, see ASHA’s Practice Portal page on Aphasia.
When selecting screening and assessment tests, the SLP considers the influence of cultural and linguistic factors on the individual’s communication style and the potential impact of impairment on function. Variations in dialect and accent are taken into consideration before marking phonemes in error if they were not part of the client’s repertoire or dialect prior to injury or disease.
The assessment is conducted in the language(s) used by the person with dysarthria, with the use of interpretation services as necessary. Some structural impairments may have a more significant impact on intelligibility of some languages than others (e.g., tonal languages, languages where aspiration of stops and nasality of vowels impact meaning). See ASHA’s Practice Portal pages on Cultural Responsiveness; Collaborating With Interpreters, Transliterators, and Translators; and Bilingual Service Delivery.
Appropriate accommodations and modifications must be made to the testing process to reconcile cultural and linguistic variations. Comprehensive documentation includes descriptions of these accommodations and modifications. Dynamic assessment is an alternative to standardized testing, when appropriate. See ASHA’s resource on dynamic assessment.
The clinician considers how changes in resonance and respiratory support impact the ability to produce a voice that is congruent with gender and gender expression. See ASHA’s Practice Portal page on Gender Affirming Voice and Communication.
See the Treatment section of the Dysarthria Evidence Map for pertinent scientific evidence, expert opinion, and client/care partner perspective.
Treatment is individualized to address the specific areas of need identified during assessment. It is provided in the language(s) used by the person with dysarthria—either by a bilingual SLP or with the use of trained interpreters, when necessary. See ASHA’s Practice Portal page on Collaborating With Interpreters, Transliterators, and Translators.
Consistent with the World Health Organization’s (WHO) International Classification of Functioning, Disability and Health (ICF) framework (World Health Organization, 2001), the goal of intervention is to help the individual achieve the highest level of independent function for participation in daily living.
Intervention is designed to
See Person-Centered Focus on Function: Dysarthria [PDF] for an example of functional goals consistent with the ICF.
Dysarthria treatment focuses on facilitating the efficiency, effectiveness, and naturalness of communication (Rosenbek & LaPointe, 1985; Yorkston et al., 2010) and supporting functional communication between the speaker and their listeners.
Restorative interventions maximize intelligibility by addressing the function of the speech production subsystems. Restorative approaches focus on improving
Compensatory interventions maximize a person’s participation in activities by addressing functional communication. Compensatory approaches focus on the following goals:
Sometimes the goal of treatment is to preserve or maintain function or to slow further decline, such as when an individual has a progressive disease.
Because dysarthria is a motor speech disorder, treatment planning considers the goal of the intervention and principles of motor learning and neuroplasticity. These principles impact how someone acquires, or learns, a motor pattern as well as how they retain and transfer those patterns (Maas et al., 2008). Principles of motor learning impact the structure of practice and feedback. Clinicians can modify practice by the amount and schedule of practice time and the variability and complexity of the targets during practice. For example, blocked, constant practice is associated with skill acquisition, whereas random, variable practice is associated with retention and transfer (Maas et al., 2008). Feedback can be modified in its frequency and focus, moving from frequent knowledge of performance feedback (e.g., “You put your lips together”) during skill acquisition to variable knowledge of results feedback (e.g., “That was correct”) during retention and transfer. Clinicians may also incorporate principles of neuroplasticity during treatment planning, including specificity of training, repetition, intensity, and salience (Ludlow et al., 2008). Clinicians consider each of these principles, their intersection with each other, and differences in their application between nonspeech and speech tasks when choosing interventions, selecting targets, and recommending dosage.
Individual client factors that may influence motor learning include
It can be important to consider the sequence of targeted subsystems in restorative approaches. For example, respiration and phonation are usually targeted initially, but prosthetic management of velopharyngeal dysfunction may be needed first to achieve efficient and effective breathing and phonation for speech (Duffy, 2020; Yorkston et al., 2010).
Some treatments have benefits that extend to subsystems other than the one being targeted. For example, improving prosody can benefit naturalness and intelligibility (Patel, 2002; Yorkston et al., 2010), and increased loudness (vocal effort) may induce changes in articulation and resonance (Neel, 2009).
As dysarthria impacts functional communication between the individual and both familiar and unfamiliar communication partners, planning for compensatory strategies considers the individual’s level of independence in self-advocacy and ability to modify their environment. For example, a dysarthric speaker with no limitations in ambulation or the use of their hands will be able to access supportive tools such as a text-to-speech app independently, whereas someone with motor limitations may be more dependent on partner support.
Individual client factors that may influence compensatory strategies include
SLPs use their independent clinical judgment and the best available evidence in partnership with the client and their care partners when selecting treatment strategies. Research continues to add new understanding of the relationship between restorative strategies and compensatory strategies. ASHA members can use ASHA Evidence Maps and ASHA journals to integrate the principles of evidence-based practice and make an evidence-based clinical decision that is appropriate for their clients. Below are brief descriptions of treatment options for addressing dysarthria. This information is not prescriptive or exhaustive, and the inclusion of any specific treatment does not imply endorsement from ASHA.
Restorative treatment approaches aim to restore function of the speech subsystems. The restorative treatment techniques below (e.g., Clark, 2014) might also be combined with compensatory treatment approaches. Certain treatment techniques may not be the best fit for every person with dysarthria or in all situations. Choosing the appropriate strategies will depend on the etiology of dysarthria, the differential diagnosis of dysarthria type, and the affected subsystems.
A variety of communication strategies can be used by the individual with dysarthria (speaker) and their communication partner to enhance communication when speech intelligibility or efficiency is reduced. These strategies can be used before, during, or after other treatment approaches are implemented to improve or compensate for speech deficits (e.g., Duffy, 2020).
Speaker strategies include
Communication partner strategies include
Environmental modification involves identifying optimal parameters to enhance comprehensibility.
These parameters include
AAC involves supplementing or replacing natural speech and/or writing.
The two forms of AAC are
Speech supplementation, a form of AAC, uses additional cues to enhance the speaker’s spoken message. Supplementation strategies, which can be low-tech or computer-based, can include (Hanson et al., 2013) the following:
Other augmentative supports include voice amplifiers, artificial phonation devices (e.g., electrolarynx devices and intraoral devices), and oral prosthetics.
See ASHA’s Practice Portal page on Augmentative and Alternative Communication.
SLPs may refer the individual to a medical specialist to assess the need for medical interventions. Medical or surgical interventions may be used in combination with behavioral interventions, as needed.
These interventions can include, for example,
Not all individuals with dysarthria are candidates for treatment. Factors influencing decisions about treatment include the individual’s communication needs, their motivation regarding treatment, and the presence of other deficits or conditions that can hinder communication.
Management of dysarthria related to neurodegenerative disease requires consideration of present needs and those that may arise over the course of the disease. The goal of treatment is to maximize communication at each stage of the disease, not to reverse decline (Duffy, 2020). This may include additional strategies to conserve energy and minimize fatigue, as well as initiating AAC systems and voice banking as early as possible following a diagnosis.
SLPs may need to provide counseling and education to clients and their care partners about the various factors influencing treatment decisions. See ASHA’s Practice Portal page on Counseling for Professional Service Delivery.
Views of the natural aging process and acceptance of disability vary by culture. Cultural views and preferences may not be consistent with medical approaches typically used in the U.S. health care system. It is essential that the clinician be responsive to client/patient and care partner wishes when sharing potential treatment recommendations and outcomes. Clinical interactions should be approached with cultural humility.
Treatment goals should take into consideration all languages and the specific dialects spoken by the person receiving services and their different communicative environments. See ASHA’s Practice Portal pages on Cultural Responsiveness, Bilingual Service Delivery, and Collaborating With Interpreters, Transliterators, and Translators.
The clinician also considers how changes in resonance and respiratory support impact the ability to produce a voice that is congruent with gender and gender expression. See ASHA’s Practice Portal page on Gender Affirming Voice and Communication.
See the Service Delivery section of the Dysarthria Evidence Map for pertinent scientific evidence, expert opinion, and client/care partner perspective.
In addition to determining the optimal treatment approach for an individual with dysarthria, the clinician considers service delivery variables—such as format, provider, dosage, timing, and setting—that may have an impact on treatment outcomes.
Format refers to the structure of the treatment session (e.g., group and/or individual). Individual treatment may be most appropriate for learning new techniques and strategies. Group treatment provides opportunities to practice techniques and strategies in a naturalistic setting and to receive feedback about their effectiveness in improving comprehensibility and overall communication. Telepractice may be appropriate for some individuals with dysarthria (Tenforde et al., 2020). See ASHA’s Practice Portal page on Telepractice for more information.
Provider refers to the person providing the treatment (e.g., SLP, trained volunteer, family member, care partner). In addition to skilled treatment provided by the SLP, care partners and other communication partners can be trained by the SLP to provide opportunities for practice, encourage the use of strategies such as AAC, and give feedback about performance in functional settings.
Dosage refers to the frequency, intensity, and duration of service. Dosage may vary depending on the individual’s type and severity of disease, energy level, motivation, and degree of community support. Individuals with dysarthria may benefit from frequent and intense practice consistent with the principles of motor learning to enhance retention of speech skills (Bislick et al., 2012; Kleim & Jones, 2008; Maas et al., 2008).
Timing refers to when intervention is initiated relative to the diagnosis. Early initiation of treatment may be beneficial for learning or relearning motor patterns; however, improvements in comprehensibility using communication strategies are possible at any point. Timing for introducing prosthetic management and/or AAC may vary with the setting, the individual’s preferences, and the severity and stage of disease.
Setting refers to the location of treatment (e.g., home, community-based). Individuals may benefit from a naturalistic treatment environment that incorporates a variety of communication partners to facilitate generalization and carryover of skills.
This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.
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Content for ASHA’s Practice Portal is developed and updated through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Dysarthria in Adults page:
The recommended citation for this Practice Portal page is:
American Speech-Language-Hearing Association. (n.d.). Dysarthria in adults [Practice portal]. https://www.asha.org/Practice-Portal/Clinical-Topics/Dysarthria-in-Adults/